Provider Demographics
NPI:1023167145
Name:HALL, STEPHANIE R L (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R L
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N WALTON BLVD STE 34
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5175
Mailing Address - Country:US
Mailing Address - Phone:479-431-6141
Mailing Address - Fax:479-282-0414
Practice Address - Street 1:202 N WALTON BLVD STE 34
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5175
Practice Address - Country:US
Practice Address - Phone:479-431-6141
Practice Address - Fax:479-282-0414
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARSP 1904OtherARKANSAS SPEECH LICENSE
AR145600721Medicaid